PFN versus DHS fixation in the management of inter-trochanteric fractures

Introduction: Intertrochanteric fracture of the femur, one of the common fractures in the elderly, is a major source of mortality and morbidity impairment in the patients. Due to problems caused by these fractures, it is absolutely necessary to use an effective and appropriate treatment modality for such patients. Many treatment methods have been used for the reduction of such fractures and the controversy still continues over the choice of implant. The aim of this study was to evaluate and compare the results in patients having intertrochanteric fracture managed with dynamic hip screw (DHS) and proximal femoral nail (PFN) fixation.Materials and Methods: In this study a total of 48 patients with intertrochanteric femoral fractures were enrolled and were randomly divided in two groups A and B. Patients of group A (N=29) were treated by ORIF with Dynamic hip screw and of group B (N=19) were treated by closed /open reduction internal fixation with long PFN. Functional outcomes and radiological assessment were compared at 3 months, 6 months and 12 months post operatively. All patients were followed up for a minimum period of 1 year. Comparison was done in terms of: Duration of surgery, total amount of blood loss during surgery, timing of early mobilization and full weight bearing, radiological assessment for callus formation and bony union, complications with technical and implant failure and Harris hip score for clinical and radiological assessment.Results: In this study mean duration of surgery in the group A (DHS group) and group B (PFN group) were found to be 58.70 and 43.20 minutes respectively. Mean blood loss in group A (DHS group) and group B (PFN group) were found to be 169.30 ml and 97.40 ml respectively. In this study among group A (DHS group), in 17 (58.62%) patients complete union occurred in 10 to 14 weeks, while in 10 (34.48%) patients complete union occurred in 14 to 18 weeks. Among group B (PFN group), in 15 (78.95%) patients complete union occurred in 10-14 weeks and in 3 (15.79%) patients, complete union occurred in 14 weeks to 18 weeks. In the group A (DHS group), superficial infection was seen in 1 (3.45%) patient, non-union in 2 (6.90%) patients and late infection 1 (3.45%) patient. In the group B (PFN group), superficial infection was seen in 1 (5.26%) patient and non- union occurred in 1 (5.26%) patient. Mean Harris Hip Score at 12-months follow-up was 79.12±0.53 and 86.80±0.48 in group A (DHS group) and group B (PFN group) respectively.Conclusion: PFN is a preferable form of osteosynthesis when treating intertrochanteric fractures compared to DHS.